leg contractures

[ejpip1]

We have a resident at our long term care facility who came to us after breaking both legs at home. The hospital/family decided not to do surgery due to her other medical conditions. The problem we have is that her legs are becoming severely contracted due to the inability of therapy to do ROM secondary to the fractures. They have attempted but feel uncomfortable due to her pain and possibly re-fracturing her legs and of course the nursing staff doesn't feel anymore comfortable. We have her pain in control as long we we don't mess too much with her legs. Does anyone have any ideas of something we could do to work with her legs to prevent the progressive contractures or if not, is there surgery that may need to be done as it has become increasingly difficult to give her personal care?

[bookwormom]

It sounds to me like this problem requires more than nursing input. Like you, I would be reluctant to do PROM. What does her personal health care provider say? (And does he or she have an awareness of how the contractures are affecting care?) Has the resident had an orthopedic and/or physical therapy consult?

[CrunchRN, ADN, RN]

A full care conference with all disciplines and family and the doc would be ideal.

[TiredMD]

We have a resident at our long term care facility who came to us after breaking both legs at home. The hospital/family decided not to do surgery due to her other medical conditions. The problem we have is that her legs are becoming severely contracted due to the inability of therapy to do ROM secondary to the fractures. They have attempted but feel uncomfortable due to her pain and possibly re-fracturing her legs and of course the nursing staff doesn't feel anymore comfortable. We have her pain in control as long we we don't mess too much with her legs. Does anyone have any ideas of something we could do to work with her legs to prevent the progressive contractures or if not, is there surgery that may need to be done as it has become increasingly difficult to give her personal care?

She's not splinted?

I'm assuming she's very elderly and has pretty significant medical problems. It's not common to pass on fixing fractures in someone who will otherwise be bedbound.

Sounds like the general plan is to make her comfortable before she dies.